ArticleBMJ global health2021
Performance assessment of the county healthcare systems in Kenya: a mixed-methods analysis.
Article in BMJ global health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Analysing the Efficiency of Health Systems: A Systematic Review of the Literature.Applied health economics and health policy · 2023Pooled it
- Technical and scale efficiency in health service production in Kenya: subnational analysis of 47 county governments.Archives of public health = Archives belges de sante publique · 2026Article
- Understanding the role of 'software' in health system capacity for non-communicable disease response: hypertension care in rural Coastal Kenya.Health policy and planning · 2026Article
- Dimensions of Health System Performance Assessment: A Scoping Review.Iranian journal of public health · 2025Review
- A laboratory-focussed desk review of health systems in Uganda, Kenya, and the UK to respond to current and future pandemics.Journal of global health · 2025Review
- Upholding the Right to Health in Contexts of Displacement: A Whole-of-Route Policy Analysis in South Africa, Kenya, Somalia, and the Democratic Republic of Congo.International journal of environmental research and public health · 2025Article
- Potential of coconut oil as a mosquito repellent.Tropical medicine and health · 2025Article
- Facilitators and barriers of Community Case management of Malaria implementation in Homabay, Busia and Kakamega Counties, Kenya.PloS one · 2025Article
- Perceptions of the benefits of the basic medical insurance system among the insured: a mixed methods research of a northern city in China.Frontiers in public health · 2023Article
- The costs and financing needs of delivering Kenya's primary health care service package.Frontiers in public health · 2023Article
- Article
- Psychometric evaluation of PHQ-9 and GAD-7 among community health volunteers and nurses/midwives in Kenya following a nation-wide telephonic survey.Frontiers in psychiatry · 2023Article
- Towards a net-zero healthcare system in Kenya: Stakeholder perspectives on opportunities, challenges and priorities.The journal of climate change and healthArticle
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Authors and funding
8 authors.
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No grant is acknowledged in the PubMed record.
Abstract
introductionA well performing public healthcare system is necessary for Kenya to continue progress towards universal health coverage (UHC). Identifying actionable measures to improve the performance of the public healthcare system is critical to progress towards UHC. We aimed to measure and compare the performance of Kenya's public healthcare system at the county level and explore remediable drivers of poor healthcare system performance.
methodsUsing administrative data from fiscal year 2014/2015 through fiscal year 2017/2018, we measured the technical efficiency of 47 county-level public healthcare systems in Kenya using stochastic frontier analysis. We then regressed the technical efficiency measure against a set of explanatory variables to examine drivers of efficiency. Additionally, in selected counties, we analysed surveys and focus group discussions to qualitatively understand factors affecting performance.
resultsThe median technical efficiency of county public healthcare systems was 84% in fiscal year 2017/2018 (with an IQR of 79% to 90%). Across the four fiscal years of data, 27 out of the 47 Kenyan counties had a declining technical efficiency score. Our regression analysis indicated that impediments to the flow of funding-measured by the budget absorption rate which is the ratio between funds spent and funds released-were significantly related to poor healthcare system performance. Our analysis of interviews and surveys yielded a similar conclusion as nearly 50% of respondents indicated issues stemming from poor budget absorption were significant drivers of poor healthcare system performance.
conclusionPublic healthcare systems at the county-level in Kenya general performed well; however, addressing delays in the flow of funding is a concrete step to improve healthcare system performance. As Kenya-and other countries-provides additional funding to meet their UHC goals, establishing a strong and robust public financial management system is critical to ensure that the benefits of UHC are realised.
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